Provider Demographics
NPI:1871054668
Name:DEDMON, WILLIAM LOGAN (DO)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:LOGAN
Last Name:DEDMON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1275 DICK LONAS RD UNIT 101
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1383
Mailing Address - Country:US
Mailing Address - Phone:865-584-4747
Mailing Address - Fax:865-584-1363
Practice Address - Street 1:103 MIDLAKE DR UPPR LEVEL
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-3002
Practice Address - Country:US
Practice Address - Phone:865-687-1973
Practice Address - Fax:833-908-2091
Is Sole Proprietor?:No
Enumeration Date:2019-03-26
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4652207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine